Anatomy of an OCD thought: Part 3 – fighting back

Click here to read Part 1.

Click here to read Part 2.

CONTENT NOTE: As with parts 1 and 2 please take care if you have religious OCD or OCD which focuses on magical thinking (i.e. if I do x then y will happen). However, I hope this post will be helpful for people who have similar OCD thoughts as in this part I will attempt to show why OCD is wrong.

The OCD situation I discuss here is described in detail in Part 2, and the OCD rationale behind it is described in detail in Part 1. In this part I am aiming to show myself (and others with similar thoughts) why OCD is wrong using cognitive reappraisal techniques.

What does OCD say?

  • I “know” (because OCD has told me) that what I did meant I was insulting the Holy Spirit and the devil.
  • They can hear my thoughts and know this too. Therefore they will be insulted unless I make it safe.
  • I used my middle finger because I was intending to insult the Holy Spirit and the devil.

What are the arguments against what OCD says?

  1. OCD is a mental illness. The thought is the symptom of an illness. If I didn’t have OCD I would not have had this thought. OCD is a mental illness which focuses on the things that matter most to the individual with OCD, and the things that cause the most fear to them. However it is a symptom of an illness, in the same way that someone with psychosis may believe they are Jesus, or someone with meningitis may get a rash. The exemplar person with psychosis believes they are Jesus, this doesn’t meant that they are. The person with OCD believes that their actions are insulting to the Holy Spirit or the devil, this doesn’t mean that they are.
  2. Christian arguments against the thought (re. the Holy Spirit). The Bible says repeatedly that God knows everything, He is omniscient. That means He knows that the thought I had was a symptom of OCD, and that I had that symptom specifically because it is the worst thing my OCD could come up with. The Bible also says that God is just – He could not be just and also knowingly condemn someone for the symptom of their illness. Furthermore, the Bible says to test the spirits and see if they are from God, and says that the Holy Spirit is not a spirit of fear. Jesus says “do not be afraid,” and “do not let your hearts be troubled” and that Christians should trust Him, not their fear. This clearly sets OCD up against Jesus and God, OCD is not on God’s side. I believe that God’s only concern with this OCD thought is that it is harming me – He doesn’t see it as offensive to Himself.
  3. Christian arguments against the thought (re. the devil). There is evidence from Biblical scholars that the devil is not meant to be read as a literal individual. Even if we did accept that he was a literal individual who could hear our thoughts, he would know that my thoughts were OCD. Furthermore, supposing we accept that hell is a place where the devil resides – in this case he is still under God’s rule, according to the Bible. He is not “in charge” of hell, according to the Bible. In this manner the power of the devil to harm me would be the same in hell as it is on earth. I am not afraid of him causing me additional harm on earth. This gets to the heart of the fear really – uncertainty and fear of the unknown (in this case death).
  4. Arguments against the notion that I intended to “give the finger” to the Holy Spirit or the devil. This argument won’t work for everyone(!) but I have never “given the finger” to anyone in my life. I never use direct insults at people, even when I’m angry. I rarely use insults when I’m talking about someone I am angry with, even if they are not there. I may have been angry with OCD when I had this OCD thought, but I was not angry with the Holy Spirit or the devil. Even if I had been I wouldn’t have sworn at them. (As an example from UK politics – I was one of the students inspired by Nick Clegg to vote for the Lib Dems, then I watched him triple tuition fees after promising to scrap them. When I met him I told him this but I stayed civil! Like many of those students I haven’t voted for the Lib Dems again, but I digress.)

So after writing all three posts in this series I have done a bit of birthday planning. This kind of OCD thought won’t diminish much until I go against it, so I’ve tried to be brave.

Advertisements

Anatomy of an OCD thought: Part 2 – the practice

Click here to read Part 1.

Click here to read Part 3.

CONTENT WARNING: In this post I discuss the content of my religious OCD. If you have religious OCD, or other forms of OCD which involve magical thinking (e.g. “if I do x then y will happen”) please take care if reading on. OCD has been known to “take on” new symptoms when hearing about other people’s symptoms. (The post starts below the picture).

I’m now going to write about a specific OCD thought that is based on the OCD lies I described in Part 1. I hope that by writing it out I can help myself to see it for what it is, and show other people what OCD looks like in detail.

A couple of weeks ago I was on my way into town and I itched my eye with my middle finger. OCD told me that this meant I was giving the middle finger to the Holy Spirit or the devil. [It is frightening for me to write that.] OCD told me that I had to “correct” it. In order to correct it, what I needed to do was itch my eye with a different finger whilst in the same position on the road and whilst listening to the same part of the song that I was listening to when I originally itched my eye. OCD says that if I can do this successfully then I will ensure that I am not insulting the Holy Spirit or the devil.

I have tried to “correct” it, but haven’t managed to do so in a way that makes me feel it’s been properly corrected and “made safe”. I can’t keep trying to make it safe at the moment, a) because I am many miles away from the place I had the thought, b) because when it comes to “correcting” something OCD is never satisfied – anyone with OCD will know that however hard you try to do as OCD wants it will keep changing the goalposts. For example it will say I wasn’t quite in the right position, or the wrong part of the song was playing (I can’t actually remember the exact position or the exact part of the song that was playing, so OCD is bound to capitalise on that).

The way it is bothering me now is that I want to plan an event for my birthday. OCD is telling me that I can’t, because the eye-itching situation has not been adequately corrected. If I were to go ahead and plan the event I would need to re-do the planning once the eye-itching thing had been made safe. This is a good example of one of OCD’s tricks – in order to stop you moving on from a situation like this it will attach itself to a situation in the future, ensuring it stays in your mind.

Another trick OCD is using at the moment is making me doubt my intentions – it’s telling me that by itching my eye with my middle finger I was intending to insult the Holy Spirit and the devil. This gives OCD more power as it’s harder to dismiss as an intrusive thought if it tells me that it was actually me who was behind the thought. I will try to tackle this in Part 3.

Anatomy of an OCD thought: Part 1 – the theory

Click here to read Part 2.

Click here to read Part 3.

CONTENT WARNING: In this post I discuss the content of my religious OCD. If you have religious OCD, or other forms of OCD which involve magical thinking (e.g. “if I do x then y will happen”) please take care if reading on. OCD has been known to “take on” new symptoms when hearing about other people’s symptoms.

OCD’s “theory”

The idea that I have insulted the Holy Spirit or the devil are the most powerful thoughts that my OCD uses. They underpin almost every OCD thought I have and every compulsion I do. I’m planning on doing a later blog post about strategies I have found useful in combating these lies that OCD tells. For now I’m mostly going to describe what they mean to me in the context of my mental illness.

There are 2 verses in the Bible in which Jesus says all sins can be forgiven, but insulting the Holy Spirit cannot be forgiven. Scholars of the Bible suggest that these verses mean that if you reject God (i.e. reject God’s gift of His Spirit) then you can’t be forgiven because you are choosing not to accept His forgiveness. The verses are not referring to a specific event or to insulting language etc. I know this, but OCD still uses the verse to terrify me. The ultimate fear behind this, for me, is the idea that if I insult the Holy Spirit I will not be saved and will not go to heaven. I no longer believe that hell is a real place, but my OCD still keeps me afraid of going there. I’ve discussed in other blog posts how having OCD means you can know that something is incorrect yet still fear it.

The second thought that OCD uses, that I could insult the devil, is also ultimately linked to a fear of hell. The OCD rationale says that if I insult the devil and one day end up in hell then the devil will single me out for specifically harsh treatment. This rationale depends on cultural notions of the devil as being in charge of hell, an idea that came into fruition long after the Bible was written. This concept of the devil as a god of hell is not actually Biblical. Even if you take the view that hell is a place, there is nothing in the Bible to suggest that the devil is in control there. In fact many Christians believe that the devil is not a specific being, but a metaphorical concept which was used at the time the Bible was written to describe the conflicting nature of the human mind – sometimes we want to (and do) do things that are wrong because it feels good, for example. The irony here is not lost on me – it’s plausible that when the Bible refers to the devil and demons afflicting people this is a pre-scientific description of what we now understand as mental illness.

One of the reasons my OCD has settled on these thoughts is that they can’t be disproved in the way that my earlier OCD thoughts could. If OCD tells me that my mum will die if I don’t stand in a certain spot, I can ignore OCD, then check if my mum is still alive. There’s no way to check whether I have insulted the Holy Spirit or the devil, and there’s no way to check whether I have stopped myself from going to heaven when I die.

Another reason why these thoughts are so powerful is that as a Christian I believe that God knows my thoughts. OCD is a condition which is based on intrusive automatic thoughts. Recovering from OCD involves accepting that you can’t control your thoughts – “but what if,” my OCD says, “by letting these thoughts go by, I am insulting the Holy Spirit and ruining not just my life but my eternity?” This is terrifying, and gives you an idea of why religious OCD is so difficult to treat.

I also fear that the devil knows my thoughts, or listens to the things I say out loud in attempt to prevent me from getting totally stuck, such as “I am not insulting the Holy Spirit or the devil if I use my left foot”. Again these fears are not based on a thoughtful reading of the Bible, but are more based on myths created by writers such as Dante.

This post has outlined some of what lies behind my OCD thoughts. Read Part 2 to see a concrete example of what this looks like in practice.

Embarrassment and shame

There’s a bonus for reading to the end today – find out how my OCD convinced a drunk man that my car was a TARDIS…

I had a bad experience today. Even though I’ve said in other posts that I can hide my OCD pretty well, since it’s been severe it’s been harder to hide in public.

I had a meeting in a new building, and was on my way out. This involved a lot of doors and steps, which was very difficult for me OCD-wise. I tend to think something along the lines of “left, right is safe” before I go through a door or down steps, and then I follow whichever pattern I have said is safe. [I won’t go into what I mean by ‘safe’ in this post, you just need to know that it is a way to prevent my worst fears happening.] Sometimes I think “left, right is safe and right, left is also safe”, or other variations, to try and give myself more flexibility. These days (as OCD is bad) I often say these things out loud if I’m alone or with people very close to me; whether I say it or think it in public depends on whether or not people would hear me.

I was walking out of the building alongside the people who had been in the meeting, one of them was directing me (as I was new to the building). It was difficult to do all my OCD thoughts and keep them hidden at the same time, but I don’t think my colleagues noticed my slight pause at the start of some of the flights of stairs.

The part where I got stuck

When we went through one of the doors near the exit I felt like I hadn’t obeyed the thought I had made (I can’t fully remember but I may have thought “right, left” was safe but not managed to follow that properly in my stepping – thinking about this makes me a bit nervous now). I had to go back to correct it, but I couldn’t do so whilst my colleagues were there. So I waited in the communal area until they were out of view, then went back to the door I was worried about.

I tried to ‘make it safe’ by going through the door and thinking the correct combination, but it was difficult as I didn’t know if my hand on the door counted as a ‘left’ or ‘right’, or if it was only the foot that I stepped with that counted. I went back and forth through the door a few times, trying to make it safe. Occasionally people walked through the corridor and I tried to pretend I’d only gone one way.

Covering my OCD

A woman in a nearby office saw me and asked if I was looking for someone, so I meekly asked where the toilets were (I already knew where they were, but I couldn’t explain what I was doing to a stranger – ironic as I’m generally a painfully honest person, partly due to my OCD). I followed her to the toilets, where I went in and texted my partner, feeling disheartened at what had happened. I didn’t go back to the door again, partly because the woman in the office next to the door might think I was a security risk(!) and partly because I tried to use my cognitive reappraisal to show myself that I didn’t need to go back again to ‘correct’ the bad thought. Now, a few hours later, I kind of half believe that it’s just OCD and half think I should go and correct it the next time I happen to be in that building.

How it feels

These sorts of symptoms are quite common, in fact there used to be a support website for people with OCD called “Stuck in a doorway”. When my OCD thoughts bleed into the real world in this way I think of what Joe Wells said in his book (“Touch and Go Joe”, about his experiences with OCD) – how can you have confidence in yourself when you can’t even get through a door? (I’m writing that from memory, so don’t quote me!)

It’s demoralising when I can’t hide OCD away. It makes me feel ashamed and ‘less than’, because I can’t just live like other people do. I also feel a bit embarrassed, as well as sad that it has got this bad.

Generally, when this sort of thing happens, people don’t seem to realise OCD is the reason for my actions. Thinking about it, maybe I prefer it that they don’t know the real reason. I feel a little ashamed (there’s that shame again) to admit that – because I want greater awareness of mental illness in society, and because it suggests that I still have some self-stigma when it comes to my mental health. Or maybe it’s OCD in particular – I find it easier to tell people I have mental illness than to tell people I have OCD.

To end on a lighter note…

It’s surprising how odd you can be in public without people noticing. A while ago I carried the same heavy, large box from my house to my car and back again 16 times whilst a man stood outside waiting for a taxi. It’s amusing to guess what he might have thought – it was a big box and a small car, so it was impossible for it to have been different boxes every time. This rules out the only logical explanation, that I was packing the car with multiple boxes. Perhaps he thought my car was a TARDIS.

OCD and school

I thought today I’d write a few things about the ways in which OCD affected my time at school. If this blog gains traction it might be useful for teachers.

Early signs

One of my earliest memories is from when I was 4 or 5. I thought I had stared at my teacher. I knew that I shouldn’t stare at people, and as a result I got very upset and started crying (because I had done something wrong). I don’t believe this was fear of being told off, because obviously no one else noticed my staring, if anything the teacher was probably pleased to have attention from one of her pupils. For me it was more focused on the notion that I had done wrong, and I should not do wrong. This isn’t OCD in itself, but it could have been an early warning sign of OCD traits, such as inflated responsibility and rigid thinking.

Fear of copying and cheating

In high school I was very concerned about copying others. When I took exams I spent the whole time with my hand covering the side of my face so I couldn’t accidentally see anyone else’s answers. I wouldn’t let my parents help me with homework as I felt I should do it myself, otherwise it would be cheating. I would struggle for hours rather than accept help.

In my GCSE History exam I put my pen down a couple of moments after the teacher told us to stop writing. When I got my GCSE results they were very good (if I may say so myself!) but I wasn’t able to enjoy them because I felt that I’d cheated on the History exam. I went to speak to a history teacher and found that I was 14 marks past the grade boundary – this reassured me a little as it wouldn’t be possible to gain 14 marks in 2 seconds. But the overwhelming feeling I experienced when I received the best set of marks of my life (they remain my best relative marks to this day), was that it was undeserved and that the whole set of GCSE marks (from all subjects) was tainted because I’d cheated in History. Now I am proud of them and I know I didn’t cheat, though I couldn’t tell you how long it took for me to get to this view.

Another related way in which OCD affected my school work was in a piece I wrote for English. The options were to write a story or an autobiographical piece. I wanted to write a story, but some of my friends had chosen that option and I thought I would be copying if I did the same thing, so I wrote the autobiographical piece instead…

Moral fears and scrupulosity

This autobiographical piece ended up being a nightmare to write, because my OCD made me feel like I needed to write it as a moral example for my teacher (with hindsight this is somewhat comical). I suppose I was frightened of writing anything that might lead my teacher astray morally. This could be seen as an example of scrupulosity, a type of OCD which is focused on religious or moral obsessions. I ended up getting one of the worst marks I’d ever received.

OCD’s interaction with my future

Talking of bad marks, OCD really interfered with my A levels as well. I had an offer to study at one of the best universities in the UK, but I needed to get top grades to finalise the offer. I was desperately anxious during that time (for a range of additional reasons), and my OCD was a nightmare.

It is difficult to remember exactly what happened with this next example, but I think it was a mixture of things. Part of it was that I had spent so much time as a teenager OCD-checking things that I struggled to engage with the action of checking, as it caused me so much anxiety. I expect I also had bad thoughts about which words I could write without terrible things happening. And I wouldn’t allow anyone to help me with my work as that would be cheating. I vaguely remember trying to print the piece of work and being scared to even look at it as it was so important that it was a huge target for my OCD and I could barely cope with the anxiety of handling it. [Writing this 12 years later I’m actually proud of myself for working so hard in the face of almost total panic].

This culminated in me submitting work with an obvious mistake in the title, and I ended up getting a D. I desperately needed an A overall in order to take up the offer I had from university, and this was a big blow to that. Eventually I told my teacher about my OCD and she advised me to exercise. She had no idea how ill I was, which I suppose was partly because I had been hiding it somewhat, but also because she didn’t know about mental illness. Her strategy (as I experienced it) when I struggled was to put more and more pressure on, and my grades got worse. I was also spending so much time on this subject that I didn’t have as much time to devote to Maths, which was the A level that I was least naturally suited to.

On results day I was woken up by my heart beat. My place at the top university had been declined because my grades were ABB. I rung them up and asked if they had considered what I had told them about being mentally ill, and the woman said they had thought about it but they had ‘sticklers for grades’ who would complain if they let me in. Two days later my first boyfriend broke up with me because I didn’t get into the university like he had done.

A happy ending (for a change)

School interacted badly with my OCD, partly because the teachers didn’t recognise that anything was wrong, and partly because I was adamant that the teachers shouldn’t know about it (until the very end, when it was so obviously harming my work that I felt that telling them was the only option). I’m trying to remember why I was so resistant to the teachers (and my GP) knowing – it was probably a mixture of not wanting to accept how ill I was (and still hoping I could get better on my own), self-stigma, fear of being treated differently, and not wanting to accept that attaining academic perfection might not be in my reach anymore, given how bad my OCD was.

But to the happy ending… if I didn’t have OCD I might well have got over the line on the grades, and gone to one of the best universities in the UK. But I was still able to go to a good university, and I’m at a similar place career-wise than I would have been if I’d gone to the other university – maybe a couple of years behind, but that’s ok. Most importantly I met my partner at the university I did attend, so whilst OCD won the battle for my A levels, I ultimately ended up better off as a result.

The time I got better

I was 10 or 11 when I became unwell with OCD. From then on, OCD stayed with me in various guises, unrelenting. I first sought medical treatment when I was 17 (before that I’d resisted attempts to get medical help). I basically went to my GP and told her I had OCD. By that point I already knew all about OCD and how it affected me.

A quick overview of some of the times I didn’t get better…

I started antidepressants when I was 17, and although I’ve tried various kinds I haven’t seen much of an improvement from any of them. I remember when I was first prescribed medicine I was so hopeful that I would get some relief, but I didn’t. Having said that, more than a decade later I’m still on a high dose of antidepressants – when I tried to come off them a few years ago my OCD got even worse.

In terms of psychotherapy I’ve seen lots of different practitioners over the years. With most therapists my OCD remained mostly unchanged, with one therapist (a psychiatrist) it got worse, and in two cases it improved. The first time it improved was when I had regular sessions with a clinical psychologist who applied cognitive behavioural therapy (CBT) techniques in a dynamic way which took account of my individual symptoms. I made some great progress, genuinely beginning to get on top of my OCD for the first time. The sessions took place over the summer, in between academic years at university. I had been in a sort-of relationship with someone from university, who didn’t like to be seen in public with me, for about 10 months. When I went back to university, and back to the stress and uncertainty of that situation, all the progress I had made over the summer just dissipated. It felt like trying to hold back water. Weeks/months of consistent hard work disappeared within 2 weeks of being back at university.

One of the most cruel things about OCD is that to get better you have to be consistent in your fight against it, which takes a lot of energy and is very frightening, but to get worse all you need to do is have a brief ‘off’ period. But don’t despair, you can get better! Which leads me on to…

The time I got better

The second time I got better my progress did stick. There were a number of factors which I think contributed to me getting well at that time.

  • My life circumstances were more settled and stable than they had been for a long time (e.g. I was now in a stable, beneficial relationship).
  • My therapist had a thorough understanding of OCD, the techniques that could be used to treat it and how to apply these techniques in an appropriate manner.
  • My therapist happened to be a Christian, which meant she could easily tell the difference between my religious OCD thoughts (which were focused on Christianity) and what was actually part of the religion itself.
  • The first ‘half’ of the treatment was focused on cognitive reappraisal (with exposure coming later on). I believe this was fundamental to my success – some people’s OCD responds well to exposure on its own, but the reason I was able to capitalise on the exposure exercises this time is that I had spent a long time strengthening my ability to reappraise the OCD thoughts. This helped me to see them for what they were, at least to some extent, and exposure then helped me to consolidate this.
  • (I changed back onto Sertraline after being on Venlafaxine. This point is in brackets as I didn’t feel an improvement from this in itself (other than the removal of Venlafaxine’s more intense side effects). But it’s possible it supported the CBT I was working on – Sertraline is a recommended medicine for OCD).

I was able to become clinically well (below the clinical threshold for OCD), and to remain well for about 1 to 2 years. I’d guess it took me about 6 – 9 months of weekly or fortnightly CBT to get there. Everyone who knew me well, including me, was amazed. I had been very ill since I was a child, and one of the things you may hear about OCD is that it has to be managed, not cured. Perhaps I just have a different concept of what ‘managed’ and ‘cured’ are, but for me, having the occasional slightly intrusive thought which I was able to bat away, a few times per day, felt like being cured.

How the world felt when I got better.

Being well felt like the world was colourful. I realised just how much I had been dealing with; I remember thinking “if this is what life is like for other people it’s no wonder I’ve been struggling so much with life.” The first Christmas I was well I joined in much more with family activities than I had previously – I had more mental space to engage with others as I wasn’t also dealing with OCD’s constant ramblings. My anxiety level was lower as I didn’t have my worst fears in my thoughts all the time. That helped me to engage more as well.

As you will have realised from the rest of this blog I became ill again. However it took a couple of years and a lot of intense interpersonal and work stress to bring it back. A few months after I had finished CBT my grandma passed away – I thought OCD would use this time of difficult emotions to stage its comeback, but it failed to do that – I kept it at bay. I wish I hadn’t got ill again, but I am optimistic that I can get well again, and stay well for longer this time. After all, this time I know it is possible, because I’ve done it before.

OCD makes it difficult to walk

I previously wrote about hand washing, a symptom of OCD that has generally reached public consciousness. Today I’m writing about how OCD makes it difficult for me to walk, a symptom that hasn’t reached public consciousness.

To explain this I’m going to label one of my worst fears ‘A’, and another of them ‘B’. For me, ‘A’ is associated with (amongst other things) the colour red, a range of colours that are similar to red, the number 6, and making a movement with my right hand or foot. ‘B’ is associated with (amongst other things) the colour white, a range of colours that are similar to white, the number 3, and making a movement with my left hand or foot. These meanings make it very difficult for me when I’m walking around.

When I walk I am highly aware of what is on the floor – where are the marks on the pavement and what colour are they? I usually have to navigate round these marks in a way that is ‘safe’. The ‘safe’ way to navigate around them varies from moment to moment, sometimes it’s safer to walk in between two marks (and make sure my foot doesn’t pass over either mark), sometimes it’s safer to walk to the left of a reddish mark, sometimes it’s safer to walk to the right. My OCD doesn’t have set rules in this sense – what is ‘safe’ varies. What stays the same is that anything vaguely similar to red or white in colour takes on excessive meaning, it is linked to one of my worst fears. For me, green and blue are safe colours, so I try to ‘direct’ my movements towards those colours (e.g. a weed between paving could be ‘safe’).

I like to listen to music, but this also interacts with my OCD when I’m walking – I have to be conscious of where I am standing on each beat of the music. I also have to be very careful what I am looking at if a singer uses insulting language, generally I try to ensure I’m looking at a ‘safe’ colour if I know bad language is coming up in a song.

Left and right are important, especially when I walk over a threshold of some kind. For example, I rarely walk from one room to another without being conscious of which foot I step with first. Whether left or right is more safe tends to vary. When I walk up/down a kerb or up/down stairs I have to be conscious which foot I step with first. If I stop walking I have to be mindful of which foot I use when I start walking again. I often think, or say, depending on who can hear me, “left right is safe, right left is also safe”. Sometimes I also add “left left is also safe, right right is also safe”.

It’s easier to walk if I can hold onto someone’s arm and look up/straight ahead, instead of at the floor. I do walk around though – I walk to and from work, and I have a dog who clearly needs to be walked! It just means that walking is quite tiring for me as I have these OCD thoughts at the same time. If I’m doing well I might manage to walk for a little while without an OCD thought, though never for a whole journey. More often OCD is present in the majority of my steps. I can usually do this whilst holding a conversation or keeping an eye on my dog – people with OCD do a lot of multi-tasking!